Dept. of Internal Medicine and Infectious Diseases, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain.
Infection. 2009 Oct;37(5):461-5. doi: 10.1007/s15010-009-8342-x. Epub 2009 Jun 4.
To describe the clinical and microbiological outcomes of patients infected with multidrug-resistant Pseudomonas aeruginosa (MDRP) treated with colistin (colistimethate sodium) and the adverse events observed with this treatment.
Retrospective study of MDRP infections treated with colistin from 1997 to 2006.
121 episodes were identified. The median daily intravenous dose was 240 mg/day; 28.9% of patients received intravenous and nebulized colistin. Clinical outcome was favorable in ten cases of bacteremia (62.5%, n = 16), 43 cases of bronchial infection (72.9%, n = 59), 13 cases of pneumonia (65%, n = 20), 11 cases of urinary infection (84.6%, n = 13), eight cases of skin and soft tissues (72.7%, n = 11), and in the one case of arthritis and one case of otitis. Eradication was achieved in 31 (34.8%) of the 89 patients with available bacteriologic data. Factors associated with bacteriological failure were smoking, chronic obstructive pulmonary disease (COPD), and previous infection with P. aeruginosa. Nephrotoxicity occurred in ten cases (8.3%), with the associated factors being previous chronic renal insufficiency, diabetes mellitus, and aminoglycoside use. Crude mortality was 16.5%, and related MDRP was 12.4%, and was higher in patients with pneumonia or bacteremia (36.1%) than in other types of infections (8.2%).
Colistin is a safe option for the treatment of MDRP infections, with acceptable clinical outcomes. However, bacteriological eradication is difficult to achieve, especially in COPD patients.
描述多药耐药铜绿假单胞菌（MDRP）感染患者接受黏菌素（黏菌素甲磺酸钠）治疗的临床和微生物学结果以及该治疗观察到的不良事件。
回顾性研究 1997 年至 2006 年期间接受黏菌素治疗的 MDRP 感染。
确定了 121 例感染。静脉注射的每日平均剂量为 240mg/天；28.9%的患者接受静脉和雾化黏菌素治疗。在 10 例菌血症（62.5%，n=16）、43 例支气管感染（72.9%，n=59）、13 例肺炎（65%，n=20）、11 例尿路感染（84.6%，n=13）、8 例皮肤和软组织感染（72.7%，n=11）和一例关节炎和一例中耳炎患者中，临床结果良好。在 89 例有可用细菌学数据的患者中，31 例（34.8%）清除了细菌。与细菌学失败相关的因素包括吸烟、慢性阻塞性肺疾病（COPD）和先前的铜绿假单胞菌感染。10 例（8.3%）发生肾毒性，相关因素为先前慢性肾功能不全、糖尿病和氨基糖苷类药物的使用。总死亡率为 16.5%，相关 MDRP 为 12.4%，肺炎或菌血症患者的死亡率（36.1%）高于其他类型感染（8.2%）。
黏菌素是治疗 MDRP 感染的安全选择，具有可接受的临床结果。然而，细菌学清除率难以实现，尤其是在 COPD 患者中。
